Provider Demographics
NPI:1073966362
Name:YAMASHITA, BRENT
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:YAMASHITA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RED OAK CANYON ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5958
Mailing Address - Country:US
Mailing Address - Phone:801-367-8579
Mailing Address - Fax:
Practice Address - Street 1:7140 SMOKE RANCH RD
Practice Address - Street 2:STE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3157
Practice Address - Country:US
Practice Address - Phone:702-320-8111
Practice Address - Fax:702-320-8112
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist